Individual
TONYA RENEE BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW, DS
Contact information
Practice address
816 SHIPLEY WAY SW, SUPPLY, NC 28462-6089
(304) 590-2459
Mailing address
816 SHIPLEY WAY SW, SUPPLY, NC 28462-6089
(304) 590-2459
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
—
—
252Y00000X
Early Intervention Provider Agency
Primary
—
WV
Other
Enumeration date
01/02/2012
Last updated
07/09/2024
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